Breaking Bad News to Learners: How Well Does the SPIKES Clinical Model Translate?

When health professions learners do not meet standards on assessments, educators need to share this information with the learners and determine next steps to improve their performance. Those conversations can be difficult, and educators may lack confidence or skill in holding them. For clinician-educators with experience sharing challenging news with patients, using an analogy from clinical settings may help with these conversations in the education context. One common model in the clinical setting for 'breaking bad news' to patients is SPIKES: Set-up, Perception, Invitation, Knowledge, Emotion, and Summary/Strategy. The authors reviewed evidence in the education setting, particularly from the remediation literature, to consider how the SPIKES model might translate from clinical settings to those in which educators must share 'bad news' with learners about their academic performance. Based on available guidelines and evidence, the authors advocate that the SPIKES model can serve as a useful framework to help educators incorporate, by way of analogy, key components into these conversations, and increase the likelihood of successful outcomes.